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Health Science Reports
ORIGINAL RESEARCH
Effectiveness of Shacklock's Neural Mobilization for
Acute and Sub‐Acute Lumbar Disc Prolapsed: A
Randomized Controlled Trial
Zahid Bin Sultan Nahid1 | Faruq Ahmed2 | Md Faruqul Islam3 | Zakia Rahman1 | Md Furatul Haque1 |
Asma Arju1 | Md Rafiqul Islam4 | Golam Moula3 | Bibekanonda Sarker5
1Department of Physiotherapy, SAIC College of Medical Science and Technology, Dhaka, Bangladesh | 2Department of Physiotherapy, Centre for the
Rehabilitation of the Paralysed (CRP), Dhaka, Bangladesh | 3Department of Physiotherapy, Dhaka College of Physiotherapy, Dhaka, Bangladesh | 4Department of
Physiotherapy, State College of Health Sciences, Dhaka, Bangladesh | 5Directorate General of Health Sciences (DGHS), Dhaka, Bangladesh
Correspondence: Faruq Ahmed (physiofaruq2020@gmail.com)
Received: 6 August 2024 | Revised: 24 February 2025 | Accepted: 7 May 2025
Keywords: low back pain | lumbar disc prolapse | physical therapy | Shacklock's neural mobilization
ABSTRACT
Background and Aims: Lumbar disc prolapse (LDP) is a more severe health issue worldwide. Shacklock's neural mobilization
is a useful technique for treating prolapsed discs. The study aimed to examine the effectiveness of Shacklock's neural mobi-
lization for acute and subacute LDP.
Methods: The study was a double‐blinded, randomized controlled trial. A total of 42 individuals with LDP were allocated
randomly by computer‐generated numbers to an experimental and a control group. The experimental group got neural
mobilization along with usual physiotherapy treatment. The control group got just usual physiotherapy. Postural education was
given for both groups in sitting and standing positions. The total number of therapy sessions was eight, with a frequency of four
sessions per week for a duration of 2 weeks. The Dallas pain questionnaire (DPQ) and Oswestry disability index (ODI)
questionnaire were measured on the initial day and after eight sessions of treatment. The data was analyzed through paired
t‐test, unrelated t‐test, chi‐square, and Mann‐Whitney U test.
Results: A significant improvement of pain in different positions and disability was demonstrated in the within‐group analysis
by paired t‐test, whereas no significant improvement was found in the between‐group analysis by independent sample t‐test.
The significant change was found on the DPQ score except for two variables. There was no statistically significant association
between disability status and gender (p= 0.69) and between disability status and BMI (p= 0.41). A significant difference
(p= 0.000) was found in both scales.
Conclusion: Shacklock's neural mobilization, along with standard physiotherapy techniques, had a significant impact on pain
and disability for people with acute and subacute LDP.
Trial Registration: Zahid Bin Sultan Nahid: CTRI/2023/04/051283
1 | Introduction
Low back pain (LBP) is the most prevalent health problem,
which is responsible for increased healthcare expenses due to
job absences and incapacity. LBP ranks fifth among illness
categories in terms of hospital care expenditures [1]. This con-
dition may arise from a prolapsed disc, hypertrophic facet or
surrounding ligaments, spondylolisthesis, or, exceptionally,
malignancy or infection [2]. The lumber disc prolapse (LDP) is
the primary source of both back pain and radiculopathy [3].
This is an open access article under the terms of the Creative Commons Attribution License, which permits use, distribution and reproduction in any medium, provided the original work is properly
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© 2025 The Author(s). Health Science Reports published by Wiley Periodicals LLC.
1 of 8Health Science Reports, 2025; 8:e70872
https://doi.org/10.1002/hsr2.70872
https://doi.org/10.1002/hsr2.70872
https://orcid.org/0000-0003-0318-475X
https://orcid.org/0000-0003-0239-0113
https://orcid.org/0009-0005-0550-1730
https://orcid.org/0009-0008-2268-2109
https://orcid.org/0009-0006-7457-8683
https://orcid.org/0000-0002-2067-469X
https://orcid.org/0000-0003-2645-4249
https://orcid.org/0009-0005-4480-6086
https://orcid.org/0000-0003-2984-1439
mailto:physiofaruq2020@gmail.com
http://creativecommons.org/licenses/by/4.0/
https://doi.org/10.1002/hsr2.70872
About 90% of the time, lumbar radiculopathy is caused by an
LDP that compresses nerve roots [4].
The LDP, a prevalent musculoskeletal condition, affects almost
10% of the global population [5]. The incidence of LDP in the
lumbar spine is highly variable, primarily due to the char-
acteristics of the population under investigation. Annual rates
vary from 2.2% in the general population to as high as 34% in
certain occupational categories [6]. Men have a larger likeli-
hood of experiencing LDP during their fourth decade of life,
whereas women had higher rates throughout their fifth and
sixth decades of life [4].
The prevalence of LDP is the leading cause of functional impair-
ment on a global scale, affecting around 1%–3% of the population
[7]. Lumbar prolapsed disc is responsible for 60%–80% of the total
number of cases of low back pain that occur over a person's life-
time in the general population [8]. The incidence of low back pain
each year is said to be between 4% and 93%. In India, 23.19% of the
population suffers from lumbar radiculopathy [9, 10]. Additionally,
due to axial stress during movement, almost 85% of those with LBP
also had further protrusion at the same level [11]. LBP leads to
psychological alterations and morbidity, including disability,
reduced engagement in both social and physical activities, and the
development of excessive fear‐avoidance behavior [12]. The
amount of disability caused by low back pain is increasing,
resulting in a significant economic burden that surpasses $50 bil-
lion a year in the United States alone [13].
Neural mobilization is a hands‐on method aimed at reinstating the
adaptability of the nervous system, which refers to the capacity of
structures surrounding the nerves to move in relation to other
similar structures [14]. According to Michael Shacklock's 2005
description, neurodynamic mobilization promotes the restoration
of nerve cells' normal physiological function, reduces pain, and
enhances performance while also helping the nervous tissue itself
regain its capacity to withstand stress and strain [15]. Numerous
studies have shown that neural mobilization is a useful technique
for treating prolapsed discs or low back pain [16].
Due to the existing ambiguity about the most efficient physio-
therapy method, further study is required to investigate the
combination of different treatments in individuals with a dis-
tinct clinical profile. There are several therapeutic options for
managing individuals with LBP; however, neural mobilization
is a recently established strategy. This study investigates the
effectiveness of neural mobilization during the first phase due
to the lack of data in this period. Although there has been a lot
of study on the usefulness of neural mobilization in patients
with LBP, the specific therapy dose, including the level of
intensity, duration, and number of repetitions, has not been
fully determined. The aim of this study was to examine the
effects of an eight‐session Shacklock's neural mobilization on
pain intensity and disability status. The research also sought to
examine the association between pain and disability with BMI
and gender.
2 | Methodology
2.1 | Study Design
This is a double‐blinded, randomized controlled trial (RCT)
design study where the assessor, physiotherapist, and partici-
pants were blinded. The researcher has conducted the study
with an experimental and a control group with an aim to
compare the between two groups.
2.2 | Ethical Considerations
The ethical requirements of the World Health Organization
(WHO), Bangladesh Medical Research Council (BMRC), and
Centre for the Rehabilitation of the Paralysed (CRP) were fol-
lowed. Before participating, patients got complete information
about the research aims and protocol and providedsigned in-
formed consent. Administrative entities of the CRP ethics
committee and the Institutional Review Board (IRB) authorized
the project. The registration number is CRP/BHPI/IRB/10/
2024/668. In addition, the trial was registered by the Clinical
Trials Registry‐ India (CTRI/2023/04/051283).
2.3 | Study Setting and Participants
Individuals with LBP and radiculopathy diagnosed as herniated
discs by MRI at the musculoskeletal unit of the physiotherapy
department at CRP between November 2022 and April 2023
were invited to take part in this study. Because these patients
came to CRP from all over Bangladesh, from all economic
groups for comprehensive rehabilitation, it reflects the entire
population. Patient eligibility criteria were patients with acute
and subacute single or multiple levels of lumbar disc prolapse
evident in MRI [17, 18], both genders, with ages between 25 and
55 years [19], and patients with prolapseddiscs with symptoms
of reduced closing dysfunction [16]. Subjects were excluded if
they had any history of surgery for lumbar disc prolapse, suf-
fered from serious pathological disease, for example, tubercu-
losis, tumour, or infection, had a history of fracture to the spine,
were pregnant, were medically unstable patients, or had any
condition where physiotherapy is contraindicated.
2.4 | Randomization
Random assignments enrolled 43 participants in either the ex-
perimental or control groups. Patients who satisfied the inclu-
sion criteria were randomly recruited from the outpatient
musculoskeletal unit of the physiotherapy department. Double
blinding was used in this investigation. After sampling, the
Summary
• Shacklock's neural mobilization is a useful technique for
treating prolapsed discs.
• The significant changes found in pain intensity between
pretest and posttest in the experimental group.
• Shacklock's neural mobilization had a significant impact
on pain and disability for people with acute and sub-
acute prolapsed disc patients.
2 of 8 Health Science Reports, 2025
researcher randomly allocated individuals by computer‐
generated random allocation to trial and control groups to
increase the thesis's internal validity. The study was reported
based on Consolidated Standards of Reporting Trials
(CONSORT) statements for presenting parallel group random-
ized trials and interventions of neural mobilization. Figure 1
depicts the research design and group distribution.
2.5 | Measurement
The researcher collected data through semi‐structured question-
naires and face‐to‐face interviews with different types of data col-
lection tools. The researcher has used the Dallas pain questionnaire
(DPQ) by using a visual analogue scale (VAS) for pain measure-
ment in different working positions and also activities; the Os-
westry disability index (ODI) questionnaire was used for disability
measurement, and the structural questionnaire was used for socio‐
demographic indicators. The interview was conducted before and
after eight sessions of treatment. The researcher was to determine
42 participants understanding of the questions by observing their
facial expressions.
2.6 | Interventions
The experimental group got neural mobilization along with
usual physiotherapy treatment, including McKenzie concept
directional treatment procedures according to patients' condi-
tions and basic physiotherapy treatment like pelvic floor, back
and leg muscle strengthening, postural advice, electrotherapy
modalities, and also given home advice. In the control group,
participants were given only usual physiotherapy treatment.
Postural advice was given in sitting and standing to both group
participants. Bothgroups received therapy 4 days a week for
2 weeks. Treatment has been given by four 5‐year‐experienced
qualified physiotherapists, and among them, two were trained
in neural mobilization. The researchers arranged special train-
ing on neural mobilization and usual care.
2.6.1 | Treatment Protocol
The neural mobilization treatment protocol was developed by
Michael Shacklock, and usual physiotherapy intervention was
provided by CRP. Table 1 shows the following treatment protocol.
FIGURE 1 | Depicts the research design and group distribution.
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2.7 | Data Analysis
The statistical analysis was conducted using IBM's statistical pro-
gram for social science (SPSS) version 22. A Mann‐Whitney U test
was used to compare the baseline variability among the categorical
data. Used paired t‐test to measure within‐group mean difference
and Wilcoxon signed rank test to calculate between‐group mean
differences. Spearman's correlation test was used to show the
association among different variables. Two‐sided 95% confidence
intervals were generated for the study. A significance level of
p‐valueDuration of suffering, n (%)
Acute (> 4 weeks) 03 (14.3%) 06 (27.3%) 0.31
Sub‐acute (4–12 weeks) 18 (85.7%) 16 (72.7%)
Pain intensity ± SD (Mean VAS in 10 cm) 6.58 ± 1.56 6.67 ± 1.38 0.35
Disability status ± SD (Mean ODI % ± SD) 54.42 ± 14.80 52.63 ± 13.75 0.58
4 of 8 Health Science Reports, 2025
3.3 | Compare Between Both Groups on Pain and
Disability Score After Shacklock's Neural
Mobilization
Before and immediately following the neural mobilization,
the median pain and disability score were compared using a
Wilcoxon signed‐rank test. A significant difference was
found in the results (p = 0.000) in both scales, whereas the
median pain and disability score after neural mobilization
(median = 3.3; 19) was lower than the median pain and
disability score before Shacklock's neural mobilization
(median = 6.5; 52) (Table 4).
3.4 | Association Between Patient's Rated
General Pain (cm) and ODI With Gender and BMI
by Spearman's Correlation
Table 5 showed that there was no statistically significant asso-
ciation between patient‐rated general pretest pain (cm) and
TABLE 3 | Dallas questionnaire (pre and post assessment by Wilcoxon signed‐rank test).
Serial Variables
Median (IQR)
p valuePre test Post test
Pair 1 Pain intensity 6.6 3.3 0.000***
Pair 2 Pain intensity at night 5.6 2.6 0.000***
Pair 3 Pain intensity with lifestyle 6.6 3.2 0.000***
Pair 4 Pain at twisting 5.3 3.5 0.010**
Pair 5 Back stiffness 4.4 3.4 0.129
Pair 6 Pain severity after walking 6.3 3.3 0.000***
Pair 7 Pain keeps from standing still 5.3 2.7 0.000***
Pair 8 Pain during walking 6.0 3.3 0.000***
Pair 9 Pain severity at forward bending 6.3 3.4 0.000***
Pair 10 Pain allows sit in upright hard chair 5.3 2.8 0.000***
Pair 11 Pain allows sit in soft arm chair 5.2 2.5 0.000***
Pair 12 Pain lying in bed 4.8 2.1 0.000***
Pair 13 Pain limit normal life style 6.5 3.2 0.000***
Pair 14 Pain interferes with work 6.5 3.2 0.000***
Pair 15 Changes office for back pain 5.3 3.8 0.062
Note: Here, the Level of significance is (and relative outcomes [27, 28]. The current
investigation observed no difference in ODI decrease between
the two groups. It is concluded that neural mobilization is an
effective tool for short‐term improvements in pain, function,
and disability associated with low back pain.
5 | Limitation
The study was conducted with a limited number of subjects and
a lack of long‐term follow‐up. Data was collected from only two
clinical settings, which is in opposition to generalizability and
might influence the findings. Another limitation is that about
25% of participants had some kind of comorbidity, likely dia-
betes mellitus, hypertension, or both, which might influence
the outcome. There is a lack of consensus in the literature re-
garding the frequency and number of repetitions of neural
mobilization techniques. In future studies, we recommend
assessing the joint range and psychological state of the partici-
pants. Similar studies with a large sample size and a follow‐up
session need to be involved.
6 | Conclusion
The study found that Shacklock's neural mobilization, along
with standard physiotherapy techniques, had a big impact on
pain and disability after eight sessions of treatment for people
with acute and sub‐acute LDP. A significant difference was
found in pain and disability status. It is revealed that neural
mobilization found improvements in pain, physical function,
and disability with prolapsed discs.
Author Contributions
Zahid Bin Sultan Nahid: conceptualization, methodology, writing –
original draft. Faruq Ahmed: methodology, writing – original draft.
Md Faruqul Islam: validation, visualization, supervision. Zakia
Rahman: conceptualization, writing – review and editing. Md Furatul
Haque: funding acquisition, investigation, resources. Asma Arju:
software, project administration. Md Rafiqul Islam: investigation,
writing – review and editing, writing – original draft. Golam Moula:
formal analysis, project administration. Bibekanonda Sarker: data
curation, validation.
Acknowledgments
The authors would like to express their gratitude to the Department of
Physiotherapy, Centre for the Rehabilitation of the Paralysed (CRP), as well
as Bangladesh, Health Professions Institute (BHPI), Dhaka, Bangladesh for
their assistance in this study.
Ethics Statement
This study was approved by the Institutional Review Board and the
Ethics Committee of Bangladesh Health Professions Institute (BHPI),
Dhaka, Bangladesh (CRP/BHPI/IRB/10/2024/668).
Conflicts of Interest
The authors declare no conflicts of interest.
Data Availability Statement
The data that support the findings of this study are available from the
corresponding author upon reasonable request.
Transparency Statement
The lead author Zahid Bin Sultan Nahid affirms that this manuscript is
an honest, accurate, and transparent account of the study being
reported.
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	Effectiveness of Shacklock's Neural Mobilization for Acute and Sub-Acute Lumbar Disc Prolapsed: A Randomized Controlled Trial
	1 Introduction
	2 Methodology
	2.1 Study Design
	2.2 Ethical Considerations
	2.3 Study Setting and Participants
	2.4 Randomization
	2.5 Measurement
	2.6 Interventions
	2.6.1 Treatment Protocol
	2.7 Data Analysis
	3 Results
	3.1 Pain Intensity Between Group Comparisons
	3.2 ODI Score (Percentage) Between Two Groups
	3.3 Compare Between Both Groups on Pain and Disability Score After Shacklock's Neural Mobilization
	3.4 Association Between Patient's Rated General Pain (cm) and ODI With Gender and BMI by Spearman's Correlation
	4 Discussion
	5 Limitation
	6 Conclusion
	Author Contributions
	Acknowledgments
	Ethics Statement
	Conflicts of Interest
	Data Availability Statement
	Transparency Statement
	References